I get a list of my highest cost patients every month. In terms of other tools, we have internal analytics. And if I'm asking myself-or the 120 doctors in our organization-to click a bunch of boxes, to find these things, to order these things, to do these things, money is a big motivator for that. It's a lot of clicks, right? There's fatigue. Value-based payments are probably the biggest tool. We have those various things, but the first-and I think the greatest-was annual wellness visits.ĪJMC: What tools or resources are most important for fulfilling the goals of an ACO or for pursuing value-based care initiatives in general? We have controlling high blood pressure, we have controlling diabetes, we have transitional care visits. It was value-based money that came into the group, and if you help elevate the group on the value-based contracts, you get that carrot. But the answer is if you do that, it's a carrot. Now, some doctors considered that a stick and thought we should be providing carrots, not sticks. If you didn't have a 70% or greater annual wellness visit rate, you lost a significant chunk of money. So, that was the first thing we did, and some of our doctors were unhappy about it, but our rate of annual wellness visits went from, if I recall, around 48% to maybe 72% in the first year. It wasn’t payer-driven-we try to be payer-agnostic-but if you have your annual wellness visit, you're more likely to have your mammogram, you're more likely to have your colon cancer screening, you're more likely to have your pneumonia shot and your flu shot-and now your shot. And quite honestly, I think that has been the biggest difference in terms of quality scores and cost savings. The first value-based measure we did was requiring 70% of our Medicare-aged patients to have an annual wellness visit. Arizona Community Physicians is a physician-owned, physician-run group-that's a lot of different individual physician practices that came together for the scale, so when the ACO was formed, a lot of what we did was trying to herd the cats. This was really the first requirement we had. Levine: One of the things that Abacus introduced was a goal that is bonused for Medicare annual wellness visits. This interview has been edited for length and clarity.ĪJMC: In your experience with Abacus Health, what population health strategies do you think have been most impactful in improving quality measures and mitigating health care costs? In an interview with AJMC, Melissa Levine, MD, a family medicine specialist at Arizona Community Physicians and medical director for the Abacus Health accountable care organization (ACO), discussed strategies for success in an ACO and how primary care can complement oncology care for patients diagnosed with cancer.
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